Rio 2016 Olympics, the Brazilian Economy, and Oncology: Where Are We Going Next?

Rio 2016 Olympics, the Brazilian Economy, and Oncology: Where Are We Going Next?

Gilberto Lopes, MD, MBA

@GlopesMD
Oct 31, 2016

Tall and tan and young and lovely!

All it took for Brazilians to jolt back to our usual optimism and hedonism was to see Gisele Bundchen dazzle a billion people around the world walking over a 100-meter long catwalk as Tom Jobim's grandson played Girl from Ipanema in the background. The opening ceremony for the Rio Olympics as a whole was a celebration of the nation, its culture, and Brazilians of all walks of life.

It was crowned by Vanderlei de Lima (no relation; the family name Lima in Brazil is kind of like Jones in the U.S., not as common as Smith but almost in the same league), a would-be Olympic gold medalist marathon runner who was stopped by a deranged man in Athens 2004 a few miles before the finish line. Despite not being able to regain leadership of the race, his wild smile, joyful demeanor, and successful expression as he celebrated his bronze medal by spreading his arms like the wings on an airplane earned him a Pierre de Coubertin medal (named for the founder of the modern games) and the honor to lit up the Cauldron at Maracanã Stadium, Rio's famed temple to football (soccer) and stage to the World Cup finals and the opening of the 2016 summer games. Vanderlei de Lima symbolizes one of our national traits: we smile and continue to enjoy life when facing adversity.

Speaking of airplanes, you may have noted a box-shaped contraption that "took flight" halfway through the show, celebrating Brazilian aviation pioneer Alberto Santos-Dumont. The 14-bis was the first self-contained aircraft to take off and fly on its own without any support from rails or slingers at a well-documented public demonstration in Paris in 1906, 3 years after the Wright brothers first flew the Kitty Hawk Flyer. Considered in Brazil to be the father of aviation, Dumont is less controversially known as the inspiration for the creation of one of the world's most famous wristwatches. His friend Louis, then a relatively unknown jeweler in Paris, presented Dumont with a watch mounted on a strap so that he could keep track of time when flying his balloons, dirigibles, and heavier-than-air flying machines. The model is still celebrated a century later as the "Santos" model from Cartier.

Time and again, however, we see that collaboration is more important in research and development than knowing who did what first. The Demoiselle (“damsel fly”) was the first airplane ever to be produced for sale. Santos-Dumont and his partners used Wilbur and Orville's wing-warping patented mechanism for roll control and it could even be ordered with a Wright engine. In June 1910, Popular Mechanics declared this airplane was "better than any other that has ever been built."

Hope started to sprout in public life in Brazil after the Olympics as well. Inflation has slowed down, allowing for a small decrease in interest rates, and consumer and investor confidence has finally begun to edge up. More importantly, a protracted impeachment process ended, giving the recently fully empowered vice-president more political power and, hopefully, the will to do what only someone not running for reelection can: to make tough, unpopular, and sorely needed adjustments. Brazil is still a young country, but we are getting old before becoming wealthy and our pension system is over-bloated and unaffordable in the long run, heavily favoring former government personnel over the common worker.

In oncology we are also seeing the first blossoms of spring. Last year we presented a study that showed that it took an average of 2.3 years for a cancer drug to be approved in Brazil after it got the green light from the U.S. Food and Drug Administration. A little bit over half of this time was due to a slow regulatory agency, ANVISA, but nearly half of the effect related to delayed filing by pharmaceutical companies. In 2016, however, the first approved anti-PD1 agent for lung cancer in Brazil got its stamp for the same indication barely 6 months after the FDA sanctioned it.  

Civil society has also started to hold nationwide discussions and action on cancer control and these have not fallen in deaf ears in the Brazilian Congress. A parliamentary front for cancer has helped pass legislation mandating treatment within 60 days of diagnosis and coverage for oral drugs in the supplemental health system. Early wins have included a struggling but still working universal health system, the lowest smoking rates in decades (less than 14% of the adult population smokes today), increasing availability of data under a Freedom of Information–like act and increasing use of early detection technology such as mammograms and Pap smears. Moreover, academic studies have started to quantify the human and economic burden of lack of access to targeted agents in the Brazilian public system, giving advocates data to support their mission. The approval of rheumatology biosimilars makes us think that oncology ones will soon come in their wake.

But progress requires focus and perseverance. Only about half of Brazilian patients with cancer start treatment within 60 days of diagnosis in the public health care system, and early gains can easily evaporate. After a successful first year of HPV vaccination in which nearly all girls between age 9 and 11 were covered, the shots were subsequently moved to public health care units rather than schools and anti-vaccination activists stirred the discourse. Vaccination rates plummeted and barely half of the goal was met.

During the opening ceremony of the Rio Olympics, a poem about a flower which sprouted out of concrete and asphalt was superbly performed in English by Dame Judy Dench and in Portuguese by Fernanda Montenegro. You might remember her as an Oscar contender for the movie Central Station; she was the letter writer who guided the young protagonist on a journey of self-discovery through often forgotten parts of Brazil. Carlos Drummond de Andrade, the author of the poem, also wrote a more famous one about a stone in the middle of the road. It is high time we start to move these obstacles.

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